CON-GUI-86

Code
CON-GUI-86
Mercy ID
V-02650-01
Encounter Date
03/03/2008
Last
Contreras
First
Guillermina
DOB
11/12/1986
County
Dekalb
Street
102 Chamblee Dunwoody Apt. 102-4
City
Chamblee
State
GA
Zip
30341-
Cell
(678) 292-3581
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Adult, no formal education
Home Owner
No

Parents Information

Name DOB COB
Mother N/A N/A N/A
Father N/A N/A N/A
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
NOTES
Lives With
N/A
Name of School
N/A
Grade
N/A
Who Can't Pickup the Child

Media

NO DOY PERMISO
Authoritation Parent
No
Authoritation Child
No
DOY PERMISO
No
Limitado Educativo
No
Limitado Impresos
No
Limitado Caminar Latino
No
Intake
J. Perez
Data Entry
J. Manzo